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7/21/2019 ARB Artroza
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ARTROZA osteoartroza
artritahipertrofca
osteoartrita
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osteoartrita
...o boala vecheca insasi
omenirea...
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ARTROZARTROZ
AA artropatie degenerativaartropatie degenerativa
pluriactoriala, heterogenapluriactoriala, heterogena
degradarea cartilajului artic.degradarea cartilajului artic. reactia hipertrofca a osuluireactia hipertrofca a osului
subcondralsubcondral
variate reactii ale celorlaltevariate reactii ale celorlaltestructuri articularestructuri articulare
modifcari clinice simodifcari clinice si
radiologiceradiologice
artropatie degenerativaartropatie degenerativa
pluriactoriala, heterogenapluriactoriala, heterogena
degradarea cartilajului artic.degradarea cartilajului artic. reactia hipertrofca a osuluireactia hipertrofca a osului
subcondralsubcondral
variate reactii ale celorlaltevariate reactii ale celorlaltestructuri articularestructuri articulare
modifcari clinice simodifcari clinice si
radiologiceradiologice
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EPIDEMIOLOGIEModificari clinice0.1% 25-35 ani10% > 65 ani
30% > 75 aniModificari radiologice1% 25-35 ani30% > 65 ani80% > 75 ani
Modificari anatomo- patologice
100% > 65 ani
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ETO!O"A #ETO!O"A #
$ATO"E%A ARTROZE$ATO"E%A ARTROZE
?
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FACTORI FAVORIA!TIGE!ERALI"
GE!ETICI
G#n#$# #n&'( )*$a+#n II, '*&#*+$i)ani
VARTA
E/L
OEITATEA
DE!ITATEA MI!ERALA OOAA
IPERMOILITATEA
ALTE OLI
D, TA, +(&a
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FACTORI FAVORIA!TIFACTORI FAVORIA!TI LOCALI
*$i)i&a'# an*'a$a, &#(&('i n*'a$#
&'# #)ani) '##&a&
T'a(a&i#
*$i)i&a'# n*'a$a, &#(&('i an*'a$#
A$&#'a'i 'ii&i4# a$# a'&i)($a&ii$*'
A$&#'a'i #)(na'# – *$i in$aa&*'ii, #&a*$i)#, #n*)'in*$*+i)#,
n#('*$*+i)#, in#)&i*a#
&el mai recvent intervin mai multi actori avorizan
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CLAIFICARE ETIOLOGICA IDIOPATICA PRIMITIVA9
EC/!DARA
Ca(:# ana&*i)#
T'a(a&i#
Ca(:# in$aa&*'ii
Ca(:# #&a*$i)#
Ca(:# #n*)'in#
Ca(:# n#('*$*+i)#
A$&# *$i Pa+#&, *&#*n#)'*:a9
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CLAIFICARE CLI!ICA
!'. a'&i)($a&ii
L*)a$i:a'#
Mana
G#n(n);i
*$C*$*ana 4#'&#'a$a
A$&# $*)a$i:a'i
ART!A()!
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ART!A()!ART&)!ARART&)!AR
*ispersarea ortei*ispersarea ortei
mecanicemecanice
+recare minima+recare minima
AdaptareaAdaptarea
supraetelorsupraetelor
osoaseosoase
*ispersarea ortei*ispersarea ortei
mecanicemecanice
+recare minima+recare minima
AdaptareaAdaptarea
supraetelorsupraetelor
osoaseosoase
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CARTILA</L ARTIC/LARCARTILA</L ARTIC/LAR
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CO!DROCITELE
C**n#n&# a$#a&'i)#i #=&'a)#$($a'#C*$a+#n II, I, I, VI, P'*&#*+$i)ani
MMPC*$a+#na:aA+'#)ana:a
G#$a&ina:a&'*#$i:ina
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&O%*RO&TE!E&O%*RO&TE!E
+unctie duala
#ensibile la ortele mecanice ⇒
E&A%OTRA%#*)&TE
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PROTEOGLICA!II
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PROTEOGLICA!II
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D#+'aa'#a a&'i)#i #=&'a)#$($a'#
MMP in&#&i:a&# )a '*#n:i#
ina)&i4#
A)&i4a&# # '*&#a:#
#'i)# a)&i4a&*'i #
$ain*+#n,
$ain*+#n9, 'ai)a$i$i#'i, )a&#in#
Ina)&i4a&# # TIMP, PAI-1
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⇑ DEGRADAREA
⇓ I!TEA IL-1
T!F- !O IL-17, IL-18 On)*&a&in M
⇑ DEGRADAREA
⇓ I!TEA IL-1
T!F- !O IL-17, IL-18 On)*&a&in M
⇑ I!TEA
⇓ DEGRADAREA IGF-1 TGF- IL-@, IL-10, IL-13 IL-1Ra OP-1 *&#*+#ni)
'*&#in9
⇑ I!TEA
⇓ DEGRADAREA IGF-1 TGF- IL-@, IL-10, IL-13 IL-1Ra OP-1 *&#*+#ni)
'*&#in9
R#)#&*'i#)ii)i
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CARTILA</L ARTIC/LAR !ORMAL
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$ATO"E%A$ATO"E%A
ARTROZEARTROZE*egradarea
progresiva a
cartilajului
articular
Reactia
hipertrofca a
osuluisubcondral
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*egradarea cartilajului*egradarea cartilajului
INITIAL:
+actori mecanici
!ezarea retelei de colagen
-iperhidratare condromalacie/
&ART!A()!&ART!A()!
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&ART!A()!&ART!A()!ARTROZ&ARTROZ&
!ezarea retelei de colagen,⇑
colagen 0
⇓ colagenului , inlocuirea cu colagen
Retea dezordonata
!ezarea retelei de colagen,⇑
colagen 0
⇓ colagenului , inlocuirea cu colagen
Retea dezordonata
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Alterarea sintezei de colagen
Dezorganizarea fibrelor de colagen II
“Dediferentierea condrocitelor”
⇓
Colagenul II, IX, XI Colagen I, III, V, X
Fenotip matur normal Fenotip anormal
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&ART!A()! ARTROZ&&ART!A()! ARTROZ&
⇓ sintezei, dimensiunilor
proteoglicanilor 1234/
⇓
agregarii pe ac.
hialuronic
nversarea raportului
8#
⇓ sinteza ac. hialuronic
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CO!DROCITELE
Eliberarea
e7cesiva deenzime
degradative si un
raspuns reparatorinadecvat
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R(#'#a #);i$i'($(iin&'# *'a'#a i
#+'aa'#a a&'i)#i#=&'a)#$($a'#
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&O%*RO&TE!E&O%*RO&TE!E
#uera diviziuni mitotice, ⇑ sinteza
componentelor matricei, $ Treptat mor
&artilajul hialin ⇒ fbrocartilaj
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CARTILA</L ARTROICCARTILA</L ARTROIC
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*egradarea cartilajului*egradarea cartilajului
ALTERAREAALTERAREACO!DROCITELORCO!DROCITELOR
ALTERAREAALTERAREAI!TEEI DEI!TEEI DE
PROTEOGLICA!IPROTEOGLICA!I
ALTERAREAALTERAREAI!TEEII!TEEI
DE COLAGE!DE COLAGE!
ALTERAREAALTERAREAI!TEEII!TEEI
DE COLAGE!DE COLAGE!
ALTERAREAALTERAREAMATRICEIMATRICEI
ETRACEL/LAREETRACEL/LARE
& O
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&TO6%E!E&TO6%E!E
!89 si T%+8!89 si T%+8
!89!89
∀⇑
%O, $":
∀⇑
$⇒
distructia cartilajului
∀⇓
componentelor matriceale
∀⇓
prolierarea condrocitelor
•Activeaza osteoclastele⇒
distructia
osului
∀⇑
sinteza cito;inelor
∀⇑
prolierarea sinoviocitelor
T%+8T%+8
∀⇑ sinteza de cito;ine∀⇑
sinteza de
chemo;ine,$",%O
∀⇑
$⇒
distructia cartilajului
•Activeaza osteoclastele⇒
distructia osului∀⇑
sinteza cito;inelor
⇑ nr. !89R
%u in talus'''
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&TO6%E!E...&TO6%E!E...
!"89!"89
•&oncentratie&oncentratie⇓
∀⇑ sinteza de proteoglicanisinteza de proteoglicani
∀⇓ eliberarea de colagenazaeliberarea de colagenaza
∀⇑ sinteza de T$sinteza de T$
!8<!8<•Rol dualRol dual
∀⇑ T%+8T%+8
RR
∀⇑ sinteza desinteza deT$T$
T"+8T"+8
•&oncentratie&oncentratie⇓
∀⇑ sinteza de proteoglicanisinteza de proteoglicani
∀⇓ eliberarea de colagenazaeliberarea de colagenaza
∀⇑
sinteza de T$sinteza de T$
∀⇓ e7presia !89Re7presia !89R
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REA&TA RE$ARATORE A O#)!)REA&TA RE$ARATORE A O#)!)#)=&O%*RA!#)=&O%*RA!
&ontribuie la durere si handicap fzic odifcarile sunt concomitente
+oarte activ metabolic>
Eburnare, hipervascularizatie, stimulare
osteoblastica⇒
neoormare de os si cartilaj
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REA&TA RE$ARATORE A O#)!)REA&TA RE$ARATORE A O#)!)#)=&O%*RA!#)=&O%*RA!
ecanism necunoscut ⇑
"+, penetrare vase,staza venoasa, cicatrizari vicioase ale
microracturilor?/
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A!ATOMIE PATOLOGICA In+(&a'#a )a'&i$a($(i
O&#*)$#'*:aO&#*i&*:a
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A!ATOMIE PATOLOGICA
Fi'i$a'#a
)a'&i$a($(iFi('i 4#'&i)a$#
A$&#'a'i)*n'*)i&a'#
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A!ATOMIE PATOLOGICA
C;i&# **a# ()*n'a$#
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A!ATOMIE PATOLOGICA
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B(i) B(i: 1B(i) B(i: 1
1. C# !/ )a'a)&#'i:#a:a)a'&i$a($ a'&i)($a' in
a'&'*:a"A. P'*)# # i'i$a'#
. Fi('i 4#'&i)a$#
C. i#'&'*i# 4i$*aa
D. In+(&a'# ana $a ia'i&i#
E. D#&aa'#a (n*' i)i'a+#n&#
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B(i) B(i: 2B(i) B(i: 2
2. /'a&*a'#$# *ii)a'i aa'$a ni4#$($ *($(i ()*n'a$
in a'&'*:a, )( ECEPTIA"A. )$#'*:a - #('na'#
. i#'&'*i# a'+ina$a
C. #*'a+ii ()*n'a$#
D. Mi)'*'a)&('i
E. C;i&# **a# ()*n'a$#
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B(i) B(i: 3B(i) B(i: 3
3. In a'&i)($a&i# a'&'*:i)a *&aa'#a ('a&*a'#$# *ii)a'iana&**-a&*$*+i)#, )(
ECEPTIA"A. in*4i&a *#'a&a
. P'#)ii&a'#a )'i&a$#$*' #;i'*=iaa&i&a
C. Li);i in*4ia$ in )an&i&a&#)'#)(&a
D. Pan( a'&i)($a'
E. In+'*a'#a i '#&'a)&ia )a($#i
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TALO/L CLI!IC
IMPTOME
D('#'#a a'&i)($a'aR#*a'#a a'&i)($a'a 30
R#()#'#a *i$i&a&ii
I*&#n&a (n)&i*na$a #i#'i&# +'a#
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M#)ani)a
O*aa
in*4ia$a
M()($a'a !#('*$*+i)a
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TALO/L CLI!ICEM!E CLI!ICE#nii$i&a&# $a a$a'#
Ma'i'# # 4*$(T(#a)&i# # a'&i *i
C'a)#n&# a'&i)($a'#
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D#*'a'i i an);i$*:#
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DIAG!OTIC PARACLI!IC
EPLORARI IOLOGICET#&# # '(&ina
T#&# #n&'( a'&'*:a#)(na'a
Ma'#'i ai #&a*$i($(i*($(i i )a'&i$a($(i
E=a#n($ $i);i($(i in*4ia$
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EPLORARI IMAGITICERai*$*+i#
CT
RM!
A'&'*)*i#
i*i# in*4ia$aMi#$*+'ai#
DIAG!OTIC PARACLI!IC
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PO!DILOA⇓ i)($(i i4
O&#*i&*:a a'+ina$a
)$#'*:a ()*n'a$a
O&#**'*:a 4#'&#'a$a
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PO!DILOA CERVICALA
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PO!DILOA CERVICALA
R#)&i&(in#a
)*$*an#i )#'4i)a$#
In+(&a'#a a&i($(i
C5-C6
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an&#'i*a'a i*&#'i*a'a
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PO!DILOA CERVICALA
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P'*&'(:ia n()$#($(i
($* C5-C6
C*'#i#
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PO!DILOA CERVICALA
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!OD/LII CMORL
Aa' in"*ni$*:aO&#**'*:a. );#(#'ann
#'ni#'#an()$#($(i ($*
a$ i)($(i i4!#&#:i, #$ii&a&i
# )$#'*:a
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PO!DILOA LOMARA
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PO!DILOA LOMARA
)*$i*:a
O&#*i&# 4*$(in*a#a # '#a&a9
)$#'*:a a'+ina$a
In+(&a'#a a&i($(i i4
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MIELOGRAFIE
Lii**$
In&'#'(#'#a
(&an&#i #
)*n&'a&
#'ni#'#a
i)($(i i4 L@-L5
OALA FORETIER
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OALA FORETIER
i#'*&*:a 4#'&#'a$a
- i(:a
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ni4#$#
a&i( &'an$()i
OALA FORETIER
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OALA FORETIER
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ARTROA MAI!II Nodulii eberden ⇒ !ondra "#$%
Nodulii &ouc'ard ⇒ (aris "##)
*izartroza
! $ii
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!*($ii ##'#n
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i#'&'*i# **aa
R#a)&i# in$aa&*a'#
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RIARTROA
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RIARTROA
A'&i). CMC *$i)# ⇓ a&i($(i a'&i)($a'
O&#*i&*:a )$#'*:a ()*n'a$a ($(=a&i#
GO!ARTROA
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GO!ARTROA
GO!ARTROA
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GO!ARTROA
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COARTROA
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COARTROA
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DIAG!OTIC DIFERE!TIAL
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DIAG!OTIC DIFERE!TIAL
C*$*ana 4#'&#'a$a. F*'#&i#'
AO&#**'*:a
M#&a&a:# 4#'&#'a$#
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DIAG!OTIC DIFERE!TIAL
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DIAG!OTIC DIFERE!TIAL
ManaPR
A'&'i&a *'ia:i)aG#n(n);iA'&'i&a '#a)&i4a
L#:i(ni &'a(a&i)#
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A'&'i&a #&i)a
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B i B i @B i B i @
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B(i) B(i: @B(i) B(i: @
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D. Di$a:ia # )*ni$i #('a$i
E. P*$ia'&'i&a '#(a&*iH
B i B i 5B i B i 5
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armacologiceEducatia pacientului
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chirurgical
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